Peaceful Childhoods – Children and Guns

THE PROBLEM

Firearms pose a huge risk to youth and children globally, as a cause of both intentional and unintentional death and injury, due to their lethal power and often easy accessibility. For children who witness their family members being shot to death, whether living in a war zone or in a Chicago neighborhood, gun violence can become a backdrop to their world. Children describe uncertainty that they will live to adulthood, and may adopt gun use in an attempt at self-defense or to fit in with the gun use culture.[1] Children who have had violence committed against them with a weapon experience higher distress levels than children who have experienced other forms of violence.[2] Gun violence exposure in children may lead to anger, withdrawal, aggression, Posttraumatic Stress Disorder, violence desensitization, and difficulty concentrating in school.[3] Globally, approximately half of all homicides are committed with a firearm, though this varies by region and country. In 2012 for people ages 15 to 29, suicide and homicide were the second and fourth leading causes of death globally; homicide claimed the lives of 21 813 children ages 5-14 in 2012 across the world.[4] Access to firearms is correlated with increased risk of being a homicide victim or completing suicide, though firearm deaths in low and middle income countries are more often homicides while in high income countries they are more often suicides.[5],[6] Firearm injuries commonly result in long-term disability from brain and spinal cord damage, altered mental health, huge economic costs, and changes in social and community relationships.[7],[8] Homes are the greatest site of gun violence against women; the presence of a gun in the house makes a woman three times as likely to die violently.[9] If in an abusive relationship the abuser has access to a gun, there is a much higher likelihood of the female being murdered; the abuse is more lethal and severe when a gun is present.[10] Most often the guns used in domestic violence situations are rifles or shotguns.[11] Firearms pose a serious danger to the lives and well-being of children.

In Canada in 2009, 72% of gun deaths were a result of suicide, and suicide attempts with a firearm have a 93% completion rate.[12] 35% of homicides committed in Canada in 2012 involved a firearm.[13] The use of handguns in homicide was more common in larger urban centres while shotguns and rifles were more often used in more rural settings; overall, two-thirds of firearm-related homicides and firearm-related violent crimes are committed with handguns.[14] Based on data from 14 hospital emergency departments across Canada, males are much more likely to be injured by firearms and the majority of firearm fatalities are due to suicide.[15]

School Shootings

In the two years following the mass shooting in Newtown, Connecticut in December 2012, there were 94 more school shootings in America, almost one per week. 70% of the shooters were minors, and over half of these shootings took place in K-12 schools.[16] Unfortunately, gun laws in the USA have not changed significantly in response to this event; some states have tightened gun laws but more states have loosened them since December 2012.[17] In contrast, after sixteen children and one teacher died in a fatal school shooting in Dunblane Scotland in 1996, a massive public campaign galvanized UK law makers to ban all private ownership of handguns with penalties ranging from heavy fines to 10 year prison sentences, resulting in thousands of hand guns being turned in.[18] After a previous school shooting in 1987, Britain passed the Firearms (Amendment) Act in 1988, banning semi-automatic and pump-action weapons and making it mandatory to register shotguns .[19]

Guns in America

American children are sixteen times more likely to die from accidentally being shot than children in other developed countries as two million American children live in homes with guns that have not been properly unloaded and locked up.[20] 88 Americans are killed each day by gun violence, and Americans are twenty times more likely to be murdered with a gun than people in other developed countries.[21] States with higher average household gun ownership have increased youth gun deaths, with similar levels of gun death for rural and urban youth. This same trend does not continue globally as the nations with highest gun ownership levels do not necessarily have the highest homicide rates.[22] In 2010, 19 392 people committed suicide with guns in the USA; 82% of youth firearm suicides used a gun belonging to a family member. The lethality and accessibility of guns makes them a common mode of suicide, and unfortunately suicide attempts with firearms are most often successful.[23] 63% of gun deaths are as a result of suicide and over 50% of suicides are committed with a gun.23, [24]In 2013 in the USA, suicide rates were higher for all age groups above the ages of 24, with highest rates among the middle aged and elderly.[25] Based on data from the Center for Disease Control, Everytown for Gun Safety found that states which required background checks for all gun sales, included unlicensed sales such as gun shows, had 48% fewer gun suicides than states which did not require background checks for unlicensed sales.[26] The safest way to protect children from gun violence is to not have any guns in one’s home, and to keep firearms away from children, but these steps are insufficient to stop gun violence. If families choose to keep guns, they should be locked with ammunition locked separately. In the USA in recent years, gun violence has become an endemic, ongoing public health concern as violence levels have stabilized since the mid-1990s but continue to exact a toll upon American children and families, with episodic outbreaks increasing the rates, as is typical of endemic conditions.[27] Gun violence needs to be managed by international and local infrastructure which can monitor violence and intervene to stop epidemic outbreaks, and through appropriate prevention measures at all levels and in multiple sectors of society involving legal, social, health-related, and educational interventions.[28]

THE SOLUTION

Does Stricter Gun Legislation Reduce Injuries and Deaths from Firearms?

The Haddon Matrix is a method of analyzing across a time continuum risks and mitigating actions that was originally used for motor vehicle fatalities but which be applied to gun safety. The lethality of weapons, the size of ammunition clips, background checks, and screening and treatment for mental illness are all factors which impact gun violence. Guns are a vector for the mobilization of kinetic energy in the form of a bullet. Changing the ability of a gun to mobilize the bullet can impact its lethality; for instance, banning automatic and semi-automatic firearms which are very effective at firing many bullets rapidly is a step towards reducing the lethality of gun violence.[29] There are activities which could be implemented at various stages of injury, including safety and storage training before violence occurs, increased emergency plans for when gun violence happens, and , as well as post-crisis counselling which together help determine the impact of gun violence.[30] Prevention efforts can include better mental health treatment, efforts at changing the association of violence with masculinity, and early childhood interventions around emotional health.[31] Certain firearms are more lethal than others and are more conducive to violence; for instance, hand guns can easily be carried secretly and semi-automatic guns are able to mobilize a bullet much quicker than other types of weapons.[32],[33]Requiring criminal background checks for the purchase of any gun should be mandatory. In 2007, Missouri repealed legislation so that unlicensed sellers, such as gun shows and online gun dealers, no longer have to do a background check on gun purchasers.[34] Since this repeal, gun homicide rates have increased by 25% in the state of Missouri.[35] Using background checks, convicted felons, domestic abusers, and people who are dangerously mentally ill can be stopped from purchasing guns. In situations of domestic violence, the presence of a gun increases the woman’s risk of being murdered by five times; therefore implementing background checks to prevent people with a history of domestic abuse from purchasing a gun could help save lives.[36], [37], [38]

Talking to Your Child

It is important to talk to children about the dangers of guns. Discussion should be focused on how precious life is when talking about why it is important not to ever play with guns. Also, it is important to remind children that if they or their friends ever find a gun, to never touch it but to immediately tell a parent. Even after talking to children about gun safety, the responsibility to never allow children access to a firearm lies with the adult, as children’s natural curiosity means that often they cannot resist touching or pulling the trigger on a gun they may find. [39] Another important step in protecting children from gun violence is to ask other parents and adults whether they have any unlocked guns in their homes before your children visits or goes to play. Although this may feel awkward, a simple question could save your child’s life – visit http://askingsaveskids.org/ for help on how to talk to other adults about gun safety and your child.

Health Care Providers and Gun Violence

Physicians and health care providers have an important role to play in preventing gun violence. Part of this role involves assessing the mental health of patients, as law enforcement may contact a physician to inquire if it is advisable that their patient be allowed to have a concealed weapon based on the mental health history of the patient. Unfortunately, there is a lack of details on how physicians should be assessing this competency, there are concerns about damaging physician-patient relations, and physicians may be subject to law suits for sharing this information.[40] There needs to be more policy structures to guide health care providers on how to assess the competency of their patients to carry concealed weapons. Health care providers should encourage media and public to focus attention on the environmental conditions and supply chains which allows guns to be used in violent crime, targeting gun traffickers, straw purchasers, and manufacturers rather than only the offender and victim.[41] Additionally, they can play an important role by talking to their patients about firearm safety in a cultural competent way, which recognizes the diversity of opinion on gun control and promotes safety in a non-judgmental, empathetic way. In order to do this, clinicians should be educated on gun safety and control, as well as collaborate with other organizations that have an interest in firearms safety.[42] A public health approach to gun violence prevention can be used which aims to stop transmission of violence by changing social norms. Cure Violence is a model which has been used in many American cities to try to curb gun violence, to varying degrees of effectiveness. It is a valuable contribution in that it considers violence prevention at individual and community levels, and provides a complementary and alternative approach to law enforcement by treating violence as a public health problem rather than only a criminal justice problem.[43]

Addressing gun violence requires action at the individual, family, community, and societal levels. On an individual level, policies should be enacted which restrict the rights of certain persons to purchase firearms. Gun-owning parents should take appropriate measures to store their firearms safely to prevent their children from gaining access to firearms. Communities should implement mandatory background checks for people interested in purchasing firearms and on a societal level, there should be a push to control gun trafficking and pass effective gun control legislation.[44] Effective solutions must be long-term in their approach, adaptive to new challenges and changes in policy and technology, and taking into consideration underlying factors of poverty, social injustice, and deprivation.[45]

GUN SAFETY

Hunting

Families in many cultures rely on the use of firearms to procure food for their families. It is important to follow basic hunter safety rules, such as always unloading, locking and storing firearms separately from ammunition after use. When talking to children about hunting, allow them to feel sadness about the death of animals, and focus discussion on the benefits of healthy meat, conservation, and most of all, gun safety.[46] Although children may receive gun safety training, they often cannot resist touching or pulling the trigger on guns they find; therefore it is the responsibility of adults and parents to keep all guns locked and unloaded.[47]

Firearm Safety Handling and Storage Tips

Treat every firearm as if it were loaded, never pointing the muzzle at someone or pulling the trigger just for fun

Keep your hands off the trigger, not trusting the safety mechanism

Store firearms in a locked box where the code or key is unknown by and inaccessible to children

Store ammunition in a locked box separately from firearms

Do not load a gun until you are ready to use it

Do not mix alcohol or drug use with firearm use

Ensure that you and those around you who are using firearms have taken the appropriate firearm safety training courses

Hiding a firearm is insufficient to keep children from accessing it

Consider adding a gun locking device which will render a gun inoperable in order to provide additional security

Store firearms unloaded and with all safety locks on when not in use [48]